Trajectories in long-term condition accumulation and mortality in older adults: a group-based trajectory modelling approach using the English Longitudinal Study of Ageing.

OBJECTIVES: To classify older adults into clusters based on accumulating long-term conditions (LTC) as trajectories, characterise clusters and quantify their associations with all-cause mortality. DESIGN: We conducted a longitudinal study using the English Longitudinal Study of Ageing over 9 years (n=15 091 aged 50 years and older). Group-based trajectory modelling was used to classify people into clusters based on accumulating LTC over time. Derived clusters were used to quantify the associations between trajectory memberships, sociodemographic characteristics and all-cause mortality by conducting regression models. RESULTS: Five distinct clusters of accumulating LTC trajectories were identified and characterised as: 'no LTC' (18.57%), 'single LTC' (31.21%), 'evolving multimorbidity' (25.82%), 'moderate multimorbidity' (17.12%) and 'high multimorbidity' (7.27%). Increasing age was consistently associated with a larger number of LTCs. Ethnic minorities (adjusted OR=2.04; 95% CI 1.40 to 3.00) were associated with the 'high multimorbidity' cluster. Higher education and paid employment were associated with a lower likelihood of progression over time towards an increased number of LTCs. All the clusters had higher all-cause mortality than the 'no LTC' cluster. CONCLUSIONS: The development of multimorbidity in the number of conditions over time follows distinct trajectories. These are determined by non-modifiable (age, ethnicity) and modifiable factors (education and employment). Stratifying risk through clustering will enable practitioners to identify older adults with a higher likelihood of worsening LTC over time to tailor effective interventions to prevent mortality.

Trajectories of multiple long-term conditions and mortality in older adults: A retrospective cohort study using English Longitudinal Study of Ageing (ELSA).

Objectives: To classify older adults with MLTC into clusters based on accumulating conditions as trajectories over time, characterise clusters and quantify associations between derived clusters and all-cause mortality. Design: We conducted a retrospective cohort study using the English Longitudinal Study of Ageing (ELSA) over nine years (n=15,091 aged 50 years and older). Group-based trajectory modelling was used to classify people into MLTC clusters based on accumulating conditions over time. Derived clusters were used to quantify the associations between MLTC trajectory memberships, sociodemographic characteristics, and all-cause mortality. Results: Five distinct clusters of MLTC trajectories were identified and characterised as: "no-LTC" (18.57%), "single-LTC" (31.21%), "evolving MLTC" (25.82%), "moderate MLTC" (17.12%), and "high MLTC" (7.27%). Increasing age was consistently associated with an increased number of MLTC. Female sex (aOR = 1.13; 95%CI 1.01 to 1.27) and ethnic minority (aOR = 2.04; 95%CI 1.40 to 3.00) were associated with the "moderate MLTC" and "high MLTC" clusters, respectively. Higher education and paid employment were associated with a lower likelihood of progression over time towards an increased number of MLTC. All the clusters had higher all-cause mortality than the "no-LTC" cluster. Conclusions: The development of MLTC and the increase in the number of conditions over time follow distinct trajectories. These are determined by non-modifiable (age, sex, ethnicity) and modifiable factors (education and employment). Stratifying risk through clustering will enable practitioners to identify older adults with a higher likelihood of worsening MLTC over time to tailor effective interventions.

Do missing teeth cause early-onset cognitive impairment? Re-examining the evidence using a quasi-natural experiment.

PURPOSE: Multiple studies have reported a positive association between missing teeth and cognitive impairment. While some authors have postulated causal mechanisms, existing designs preclude assessing this. METHODS: We sought evidence of a causal effect of missing teeth on early-onset cognitive impairment in a natural experiment, using differential exposure to fluoridated water during critical childhood years (ages 5-20 years) in England as the instrument. We coded missing teeth from 0 (≤ 12 missing) to 3 (all missing) and measured the association with cognitive impairment in the English Longitudinal Study of Ageing data (2014-5), covering 4958 persons aged 50-70 years. RESULTS: We first replicated previous evidence of the strongly positive association of missing teeth with cognitive impairment (ß = 0.25 [0.11, 0.39]), after adjusting for socio-demographic covariates, such as age, gender, education, and wealth. Using an instrumental variable design, we found that childhood exposure to water fluoridation was strongly associated with fewer missing teeth, with being exposed to fluoridated water during childhood (16 years) associated with a 0.96 reduction in the missing teeth scale (ß = - 0.06 [- 0.10, - 0.02]). However, when using the instrumented measure of missing teeth, predicted by probability of fluoride exposure, we found that missing teeth no longer had an association with cognitive impairment (ß = 1.48 [- 1.22, 4.17]), suggesting that previous oral health-cognitive impairment associations had unobserved confounding. CONCLUSIONS: Our findings are consistent with the possibility that unobserved confounding leads to the oft-observed association between missing teeth and early-onset cognitive impairment, suggesting that the relationship is spurious rather than causal.

The Effect of Caries on the Chewing Ability of Children: A Scoping Review.

Childhood caries might have several effects on the children's general health and growth, including chewing ability. This study aims to identify the evidences found regarding the effect of caries on the chewing ability of children through a scoping review. A scoping review literature search was performed in three databases (Scopus, PUBMED, and Web of Science) without restricting the publicized year. The selected articles were using human as its subjects and aiming to analyze the effects of caries on mastication ability in children. Ten articles matched the inclusion criteria of this review. All the articles suggested a deleterious effect of caries on masticatory performance, maximum bite force, swallowing threshold, and even masticatory behavior. Two of them stated that the effect was reversible by giving dental treatment. This scoping review concludes a negative effect of caries on the children's chewing ability.

Trends in pharmaceutical opioid consumption in the WHO Eastern Mediterranean Region, 2010-2019.

Background: Pharmaceutical opioid consumption has been increasing worldwide, but disparities in access to these medications exist. Few countries of the WHO Eastern Mediterranean Region have well defined pain management policies. Aims: This study presents trends in the consumption of pharmaceutical opioids in the 22 countries in the Eastern Mediterranean Region from 2010 to 2019, with comparative intra- and extra-regional analyses; the correlation between pharmaceutical opioid consumption and human development index rankings; and pharmaceutical opioids use in the region. Methods: We calculated the defined daily doses for statistical purposes (S-DDD) per million inhabitants per day of pharmaceutical opioids from 2010 to 2019, and used the mixed effects models to assess changes in consumption. We used regression analyses to establish the strength of associations between human development index level and consumption in the region and elsewhere. Results: Pharmaceutical opioid use has fluctuated in the region since 2010, with a mean sum of S-DDD of 2547 for 2010-2019. Consumption is relatively low in the region irrespective of the human development index. The highest-consuming country reported 369 S-DDD in 2019 and the lowest reported 1 S-DDD. The most used pharmaceutical opioids in the region were fentanyl, morphine, pethidine, oxycodone, and codeine. Conclusion: Consumption could be considered inadequate in several countries of the region. Supporting these countries to improve collection and reporting of consumption data, and providing humanitarian assistance to enhance access to pain relief, should be a priority for the international community.

Comparison of Length of Hospital Stay for Community-Acquired Infections Due to Enteric Pathogens, Influenza Viruses and Multidrug-Resistant Bacteria: A Cross-Sectional Study in Hungary.

Community-acquired infections (CAI) can affect the duration of care and mortality of patients. Therefore, we aimed to investigate these as well as factors influencing the length of hospital stay in patients with CAI due to enteric pathogens, influenza viruses and multidrug-resistant (MDR) bacteria. We obtained data on 531 patients with CAI from the medical databases of a Hungarian university hospital and analyzed their characteristics using a regression model. Patients with MDR bacterial infection had the highest mortality (26.24%) and they stayed significantly longer in the hospital than cases with other CAIs. Our results showed that infection by Clostridioides difficile (odds ratio (OR): 6.98, 95% confidence interval (CI): 1.03-47.48; p = 0.047), MDR Escherichia coli (OR: 7.64, 95% CI: 1.24-47.17; p = 0.029), MDR Klebsiella spp. (OR: 7.35, 95% CI: 1.15-47.07; p = 0.035) and hospitalization in the department of pulmonology (OR: 5.48, 95% CI: 1.38-21.76; p = 0.016) and surgery (OR: 4.19, 95% CI: 1.18-14.81; p = 0.026) significantly increased, whereas female sex (OR: 0.62, 95% CI: 0.40-0.97; p = 0.037) and hospitalization in the department of pediatrics (OR: 0.17, 95% CI: 0.04-0.64; p = 0.009) decreased the odds of staying in the hospital for more than 6 days. Our findings provide new information on the epidemiology of CAI and can contribute to the development of public health programs that decrease the burden of infections acquired in the community.

Influenza Vaccination Coverage and Its Predictors among Self-Reported Diabetic Patients-Findings from the Hungarian Implementation of the European Health Interview Survey.

In high-risk populations, such as the elderly or those with serious medical issues, for instance, people with cardiovascular diseases or diabetes, influenza can have devastating effects because it might contribute to severe complications or even death. This makes vaccination against influenza an essential component of public health. The primary objective of our research was to identify the characteristics that influenced whether an individual chose to become vaccinated against influenza, with an emphasis on whether they reported having diabetes. The data were obtained from the Hungarian implementation of the European Health Interview Surveys, which were conducted in 2009, 2014, and 2019. The total sample size was 15,874 people. To determine the variables that were related to vaccination, a multivariate logistic regression analysis that included interactions was performed. The overall vaccination coverage was 13% in 2009 and 12% in 2014 and 2019 among non-diabetic respondents; the coverage was 26% in 2009, 28% in 2014, and 25% in 2019 among diabetic respondents. Despite vaccination coverage in both groups being below the optimal level of 75%, we were able to identify factors influencing vaccination coverage. Among diabetic respondents, younger age, lower education level, sex, and co-morbidities were factors that influenced vaccination status. It is important for authorities managing healthcare and medical practitioners to be aware of the potential effects that influenza can have on diabetic patients; therefore, more efforts need to be made to increase the number of diabetic people receiving a vaccination against influenza.

Investigating longitudinal associations of hair cortisol and cortisone with cognitive functioning and dementia.

We rigorously investigated potential longitudinal associations of hair cortisol and cortisone with verbal memory, time orientation, and dementia, adjusting for sociodemographic and health confounders. Data from the English Longitudinal Study of Ageing wave 6-9 (6-year follow-up, covering 4399 persons aged 50+) were analysed using linear random effects and cox regression models. In unadjusted models, hair cortisol was associated with worsened verbal memory (ß 0.19; SE 0.08), but not with time orientation (ß 0.02; SE 0.01), or dementia (ß 0.07; SE 0.16). Hair cortisone was associated with worsened verbal memory (ß 0.74; SE 0.14) and time orientation (ß 0.06; SE 0.02), but not with dementia (ß 0.47; SE 0.28). However, in the fully adjusted models, neither hair cortisol nor cortisone was associated with verbal memory, time orientation, or dementia. Consistent with prior studies, we found that more advanced age was associated with worsened verbal memory (ß 0.15; SE 0.01), time orientation (ß 0.01; SE 0.00), and dementia risk (ß 0.11; SE 0.02). Our rigorous analyses did not detect robust associations of neither hair cortisol nor cortisone with cognitive functioning or dementia across 6 years. More detailed insights into potential mechanisms are discussed.

An Exploratory Assessment of Factors with Which Influenza Vaccine Uptake Is Associated in Hungarian Adults 65 Years Old and Older: Findings from European Health Interview Surveys.

Influenza vaccination is an imperative public health task for elderly people due to a higher risk of developing more severe complications. The main aim of our study was to determine the influencing factors of being vaccinated against influenza among subjects aged 65 and above. Data were from the Hungarian implementations of the European Health Interview Survey 2009, 2014 and 2019 studies with a final sample size of 3355. A multivariate logistic regression model with interactions was used to identify the possible factors associated with vaccination. Approximately 32% of the participants were vaccinated for the most recent influenza season. The most important factors were identified that contributed to influenza vaccination among individuals, which were the following: educational attainment, having a partner, the annual frequency of specialist and doctor visits, and having comorbidities. Respondents who thought that they could do a lot for their health had higher odds of being immunized. Being obese seemed to be a risk factor. According to our findings, the current influenza vaccination coverage was considered as low in Hungary; hence, the implementation of minor reformulations in the field of health policy is suggested.

Metabolic syndrome and periodontitis among adults: The 2018 Indonesia National Health Survey.

AIM: This study aimed to examine the association between metabolic syndrome (MetS), its components, and periodontitis among Indonesian adults. MATERIALS AND METHODS: Cross-sectional data from the 2018 Indonesia National Health Survey (Riskesdas) was analysed. The sample included dentate individuals aged 35 years or older for whom complete information was available on components of MetS and periodontitis, including bleeding on probing (BOP) (N = 13,356), pocket depth (PD) (N = 13,273), and clinical attachment loss (CAL) (N = 13,000). Rate ratios (RRs) and 95% confidence intervals (CIs) were estimated with negative binomial regression models. RESULTS: The prevalence of MetS was 41.0%. The prevalence of individuals having at least one tooth with BOP, one tooth with PD ≥4 mm, or one sextant with CAL ≥4 mm was 74.9%, 40.7%, and 40.6%, respectively. No associations were observed between MetS and BOP, PD, or CAL, but hyperglycaemia was constantly positively associated with BOP (RR = 1.06; 95% CI 1.01-1.11), PD (RR = 1.13; 95% CI 1.03-1.23), and CAL (RR = 1.15; 95% CI 1.08-1.23). CONCLUSIONS: Our findings support the potential influence of hyperglycaemia on periodontitis. Incorporating oral disease prevention strategies into the management of systemic diseases could be beneficial for reducing the burden of these diseases in Indonesia.

Gender differences in informal payments for healthcare: evidence from 34 African countries.

Informal payments are widespread in many healthcare systems and can impede access to healthcare and thwart progress to achieving universal health coverage, a major element of the health-related Sustainable Development Goals. Gender may be an important driver in determining who pays informally for care, but few studies have examined this, particularly in low- and middle-income countries. Our study aimed to examine gender disparities in paying informally for healthcare in Africa. We used Afrobarometer Round 7 survey data collected between September 2016 and August 2018 from 34 African countries. The final sample was composed of 44 715 adults. We used multiple logistic regression to evaluate associations between gender and paying informally to obtain healthcare. Our results show that 12% of women and 14% of men reported paying informally for healthcare. Men were more likely to pay informally for healthcare than women in African countries [odds ratio 1.22 (95% confidence interval 1.13-1.31)], irrespective of age, residential location, educational attainment, employment status, occupation and indicators of poverty. To make meaningful progress towards improving universal healthcare coverage in African countries, we must improve our understanding of the gendered aspects of informal payments in healthcare, which can act as both a barrier to accessing care and a determinant of poor health.

Awareness Related to Cardiometabolic Diseases: A Cross-Sectional Study in Southern Vietnam.

BACKGROUND: the prevalence of cardiometabolic diseases (CMDs), such as type 2 diabetes mellitus (T2DM) and hypertension, is increasing rapidly in developing countries. This study aims to assess the awareness of CMD among a selected population in Vietnam. METHOD: a cross-sectional random sample of 402 Vietnamese citizens in two districts (Thu Duc and 12th district) in Ho Chi Minh City were interviewed. Data on knowledge, attitude, and preventive behavior (KAB) of the two conditions were collected through an interview-based questionnaire. RESULTS: the mean (± SD) age was 47.75 (± 15.61) years, and around 60.2% were female. Multiple logistic regression was performed to explore the association of sociodemographic factors, disease status, and awareness of the CMD. Females showed better awareness than males (OR = 3.89 (1.28-11.78)), and those with T2DM and hypertension had a significantly better awareness (OR = 8.33 (2.44-28.37)) than those without CMD. CONCLUSION: the awareness of CMD in our sample was poor. An extensive effort to increase awareness of CMD prevention is needed. Future studies and interventions can be developed more efficiently by targeting the right population.

Effectiveness of the school-based oral health promotion programmes from preschool to high school: A systematic review.

BACKGROUND: Schools offer an opportunity for oral health promotion in children and adolescents. The purpose of this study was to conduct a systematic review of the influence of school-based oral health promotion programmes on oral health knowledge (OHK), behaviours (OHB), attitude (OHA), status (OHS), and quality of life (OHRQoL) of children and adolescents. METHODS: A systematic search on the PubMed and Embase databases was conducted to identify eligible studies. The last search was done on April 24th, 2020. The quality of the included studies was evaluated using the Joanna Briggs Institute (JBI) Critical Appraisal tools. RESULTS: Of the 997 articles identified, 31 articles were included in this review. Seven studies targeted students in preschools, seventeen in elementary schools, and seven in high schools. Most of these studies revealed positive outcomes. Some studies showed that the school-based oral health promotion programmes showed better OHK, OHB, OHS, and OHRQoL. CONCLUSION: Positive results were obtained through oral health promotion programmes in schools, especially those involving children, teachers, and parents.

Association between Oral Hygiene and Metabolic Syndrome: A Systematic Review and Meta-Analysis.

Emerging evidence has linked poor oral hygiene to metabolic syndrome (MetS), but previously, no summary of evidence has been conducted on the topic. This systematic review and meta-analysis aims to evaluate the associations of oral hygiene status and care with MetS. A systematic search of the PubMed and Web of Science databases from inception to 17 March 2021, and examination of reference lists was conducted to identify eligible observational studies. A random-effects model was applied to pool the effects of oral hygiene status and care on MetS. Thirteen studies met the inclusion criteria and had sufficient methodological quality. Good oral hygiene status (OR = 0.30 (0.13-0.66); I2 = 91%), frequent tooth brushing (OR = 0.68 (0.58-0.80); I2 = 89%), and frequent interdental cleaning (OR = 0.89 (0.81-0.99); I2 = 27%) were associated with a lower risk of MetS. Only one study examined the association between dental visits and MetS (OR = 1.10 (0.77-1.55)). Our findings suggested that there might be inverse associations of oral hygiene status, tooth-brushing frequency, and interdental cleaning with MetS. However, substantial heterogeneity for tooth-brushing frequency and inconsistent results for oral hygiene status in subgroup analyses were observed. There was insufficient evidence for the association between dental visits and MetS. Further longitudinal studies are needed to investigate these associations.

Analysis of the labelling of a sample of commercial foods for infants and young children in 13 countries.

The World Health Organisation (WHO), European Commission (EC) and Public Health England (PHE) published evidence of inappropriate content, marketing and labelling of commercial foods for infants and young children. Despite this, EC regulations are not yet established. To reduce rates of noncommunicable diseases (NCDs) a better understanding of the food environment is needed. This study aimed to assess the labelling and listed macronutrient and sodium content of commercially available pureed foods marketed for infants and young children under 3 years of age (0-36 months) in 13 countries. A standardized protocol was developed to guide photograph collection and a sample of 155 products were obtained. All products were within current WHO and EC guidelines. However, 103 (67.7%) products were marketed for infants between 4 and 6 months, and many and contained added sugars. Action is needed to improve the nutrient composition, marketing and labelling of these products to reduce NCDs.

Lifestyle and psychosocial correlates of oral hygiene practice among Indonesian adolescents.

Poor oral hygiene leads to poor oral health, which in turn has negative impacts on overall health and quality of life. This study aimed to evaluate the prevalence and associated factors of oral hygiene practice among school-going adolescents in Indonesia. Secondary analysis of cross-sectional, nationally representative data from the 2015 Indonesia Global School-based Health Survey, covering 11,142 students aged 11-18 years, was performed. Multiple logistic regression was employed to explore associations between lifestyle, psychosocial factors, and tooth-brushing frequency. Around 10.8% of the students brushed their teeth less frequently than the recommended twice-daily regimen. Male gender, lower socio-economic status, poor dietary practice, longer sedentary time, drug use, psychological distress, less peer support, and no parental support were associated with infrequent tooth brushing. The findings support the need to integrate oral health promotion into general health actions that target families, schools, and social environments of adolescents to develop healthier habits.

Factors Affecting Dental Service Utilisation in Indonesia: A Population-Based Multilevel Analysis.

This study aimed to examine the prevalence of dental service utilisation in Indonesia and its association with social determinants at individual and community levels. Cross-sectional data from the 2014 Indonesian Family Life Survey (IFLS-5) was analysed. Individual independent variables included age, sex, marital status, educational attainment, economic status, health insurance, dental pain, self-reported mouth ulcers, self-rated health status, unmet healthcare needs and smoking status, while community independent variables included cognitive, structural social capital and residential area. Multilevel logistic regressions were performed to explore the associations between independent variables at different levels and the outcome of dental service utilisation. Of the total sample of 16,860 adults aged 15 years or older in our study, around 86.4% never visited a dentist. Dental service utilisation was associated with older age, female, currently not married, higher education level and economic status, health insurance, dental pain, self-reported mouth ulcers, met healthcare needs, never smoking, living in urban areas and communities with high structural social capital. Both individual and broader social determinants influenced dental service utilisation in Indonesia. These factors should be considered in the formulation of oral health policies and programmes aiming to improve dental service utilisation in the country.